Provider Demographics
NPI:1124091921
Name:SIMONSON, JOHN K (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:K
Last Name:SIMONSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:BLAIR
Mailing Address - State:NE
Mailing Address - Zip Code:68008-1128
Mailing Address - Country:US
Mailing Address - Phone:402-426-4611
Mailing Address - Fax:402-426-4642
Practice Address - Street 1:812 N 22ND ST
Practice Address - Street 2:
Practice Address - City:BLAIR
Practice Address - State:NE
Practice Address - Zip Code:68008
Practice Address - Country:US
Practice Address - Phone:402-426-4611
Practice Address - Fax:402-426-4642
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19620207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025024000OtherMEDICAID RHC
NE47042628508Medicaid
269125Medicare PIN
NE10025024000OtherMEDICAID RHC